The following individuals reported relevant financial relationships with commercial interests:

The following individuals reported relevant financial relationships with commercial interests:

Planning Committee Members: Karen F. Novak, DDS, MS, PhD, spouse is a consultant for

Biomedical Development Corporation; Teri Turner, MD, MPH, MEd, educational consultant for

Abbott Pharmaceuticals

Presenter(s): None

The following individuals reported no relevant financial relationships with commercial interests:

Planning Committee Members: Dorene F. Balmer, PhD; Joan Friedland, MD, MPH; Mark John

Harbott, MD; Harold A. Henson, BS, MEd, RDH; Nadia Ismail, MD; Allison R. Ownby, PhD, MEd;

M. Tyson Pillow, MD, MEd; Susan P. Raine, MD, JD; Chirayu J. Shah, MD; Eric J. Silberfein, MD;

Geeta Singhal, MD, MEd ; Sandra Haudek, PHd

Presenter(s): Charlene Dewey, MD

The Professional Health and Wellness of the Faculty Member. Charlene M. Dewey, M.D., M.Ed., FACP. Center for Professional Health – © 2014

Charlene M. Dewey, M.D., M.Ed., FACP

Associate Professor of Medical Education and Administration

Associate Professor of Medicine

Co-Director, Center for Professional Health

Chair, Faculty and Physician Wellness committee

Director, Educator Development Core

Baylor College of Medicine – Center for Professionalism in Medicine

October 16, 2014


Conflict of Interest

Charlene Dewey

….has NO financial relationships to disclose.


Goals

The purpose of the session is to provide an overview of the professional health and wellness spectrum, review the symptoms and treatments for each area, and provide opportunity for participants to reflect on their risks, as well as, identify measures to help reduce stress, prevent burnout and avoid impairment.


Objectives

Participants attending this session will be able to:

1.

2.

Describe the professional health and wellness spectrum.

Compare and contrast symptoms, treatments, and preventive measures for stress, burnout and impairment.

3.

4.

Asses their personal risk factors for burnout and impairment.

Express their willingness to modify behaviors that promote self-care and wellness.


Agenda

1.

2.

3.

4.

5.

6.

7.

Introduction

PHW spectrum – overview

Stress and burnout

Impairment

Prevention & Treatment

Resources

Summary


Reflective Practice


Professional Health & Wellness



Work Environment Home Environment

Mind Body

Self-Care

Soul Emotion



Spectrum


Stress

Image from: http://www.bing.com/images/search


Stress





What stresses you out?

Measure your stress level

The Doctor Dewey Inst-O-Matic, Stress-O-Meter

Anxious

Engaged

Enthusiastic

Calm

Relaxed

Stress free

Run Down Stressed out

Exhausted

Overwhelmed

Drained

Ready to cave

Burnt out


Stress


Identifying Stress Reactions





How do you know you are stressed?



What would other’s say about your stress behaviors?

How do you reduce or manage stress?


Managing Stress and Flooding









Self-awareness: recognize stress behaviors & feelings

Things to do when acutely stressed or flooded:



Step away from the situation (restroom)





Self-regulate, breathe, relax

Practice mindfulness techniques



Tend to the conflict

Reflect on event triggers, symptoms, behaviors

Seek coaching & mentoring


Self-Regulation Exercise









1 minute

Think about a trigger that stresses you

Monitor and regulate breathing and heart rate

Categories – practice foods in grocery store, sports teams, favorite book characters, movie titles, colors, etc.

Things in a grocery store…

1. Milk

2. Eggs

3. Bread

4. Carrots

5. Apples

6. A restroom

7. Check out station

8. Ice cream…


Burnout


Burnout

Exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration

~Webster’s dictionary

“In the current climate, burnout thrives in the workplace. Burnout is always more likely when there is a major mismatch between the nature of the job and the nature of the person who does the job.

Burnout is ‘an erosion of the soul.’ ~Christina Maslach

Maslach & Leiter . The Truth About Burnout: How Organizations cause Personal Stress and What to Do About It. 1997; pg 9.


External & Internal Systems


Burnout







“The seeds of burnout may be sown in medical school and residency training, where fatigue and emotional exhaustion are often the norm.”

~Spickard

∼

Up to 50% of medical students

∼

78% of residents

∼

48% of physicians

(range 30-60% meet one criteria/experience burnout.)

Emergency medicine and primary care specialties with increased prevalence of burnout

Scientist ?? Nurses – varies 21-54%

Spickard A. Jr, Gabbe S, Christensen JF. Mid-Career Burnout in Generalist and Specialist Physicians. JAMA. 2002;288(12):1447-1450

Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and Suicidal Ideation among U.S. Medical Students. Ann Intern Med. 2008(149):334-341.

Campbell J, Prochazka AV, Yamashita T, Gopal R. Predictors of Persistent Burnout in Internal Medicine Residents: A Prospective Cohort Study. Academic Medicine, October 2010, Vol. 85(10):1630-34. Article at: http://journals.lww.com/academicmedicine/Fulltext/2010/10000/Predictors_of_Persistent _Burnout_in_Internal.24.aspx

Shanafelt TD, Boone S, Tan L, et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Published online August 20, 2012; E1-9. Article at: http://archinte.jamanetwork.com/article.aspx?articleid=1351351&link=xref


Six Sources of Burnout

1.

2.

3.

4.

5.

6.

Work overload

Lack of control

Insufficient reward

Unfairness

Breakdown of community

Value conflict

Maslach & Leiter, 1997. “The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It.”


Risk Factors for Burnout





Single

Family of origins





Fatigue & sleep deprivation

Lack of resiliency/coping















Personality types

Gender/sexual orientation

Minority/international

># of children at home

Family problems & Life’s transitions

Mid-late career

Poor self-care











General dissatisfaction

Previous mental health issues

(depression)

Alcohol and drugs

Practice types; teaching & research demands

Potential litigation

1) Puddester D. West J Med 2001;174:5-7; 2) Myers MJ West J Med 2001;174:30-33; 3) Gautam M West J Med 2001;174:37-41

4) Center for Professional Health, course data.


Symptoms of Burnout

1.

2.

3.

4.

5.

Chronic exhaustion

Cynical and detached

Emotions: Anger, Sadness, & Fear

Increasingly ineffective at work

Leads to:

1.

2.

3.

4.

Leads to professional isolation

Avoidance

Interpersonal conflicts

High turnover http://www.bing.com/images/search

Maslach & Leiter, 1997. “The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It.” pg 17


Burnout

 Consequences of burnout:





















Reduced satisfaction

Negative emotions

Professional isolation - individual is often blamed

Poor relationships (work & home)

Risk of errors (work & home)

Possible legal or financial costs

Increased turnover

Lack of coping

Risk of suicide (MH & SA)

Potential to “spiral” into impairment http://www.bing.com/images/search


Impairment

STROKE


Impairment

“Every physician is responsible for protecting patients from an impaired physician and for assisting an impaired colleague.”

~ACP Ethics Manual

“Physicians have an ethical obligation to report impaired, incompetent, and/or unethical colleagues in accordance with the legal requirements in each state…”

~ AMA

Ethics Manual, 5 th Edition. American College of Physicians 190 N. Independence Mall West. Philadelphia, PA. 19106-1572

AMA: Opinion 9.031 - Reporting Impaired, Incompetent, or Unethical Colleagues at: http://www.ama-assn.org/ama/pub/physicianresources/medical-ethics/code-medical-ethics/opinion9031.page

?


Impairment

AMA: “…any physical, mental or behavioral disorder that interferes with ability to engage safely in professional activities...”

1.

Physical impairment

2.

3.

4.





Cognitive impairment

Psychological impairment

Substance use disorders (licit and illicit drugs)

Mental health disorders (depression & suicide)

Behavioral – behaviors that undermine a culture of safety

AMA Polices Related to Physician Health, 2011 http://www.ama-assn.org/resources/doc/physician-health/policies-physicainhealth.pdf

- Accessed 8/13/2012


Progression of Substance Use

At

Risk

Normal Use Abuse

Intervention

& Treatment

Experimentation At Risk Use Dependence Recovery


Substance Abuse

“Addiction doesn’t come heralded by a brass band, it sneaks up on you, and sometimes with extraordinary speed.”

~C. Everett Koop (former US Surgeon General), 2003


Prevention & Treatments


Resiliency


Resiliency





Resiliency is one’s ability to experience events and adapt or overcome the situation, hardship or stress.

Resiliency can be taught and helps reduce stress and prevent burnout in physicians.

Inner calm

Emotional resilience

Cognitive resilience

The Road To Resilience – APA article @ http://www.apa.org/helpcenter/road-resilience.aspx#


Four Strategies for Enhancing

Resiliency


Self-Care


Self-Care

 Do you feel empowered to demand your own self care?







Place yourself as #1 on the ‘to do’ list

Identify your own needs & fill them

Listen to your body = practice self-care


Self-Care

Seven self-care issues:

1.

Sleep

2.

3.

4.

5.

6.

7.

Balanced meals

Physical activity

Socialization/hobbies

Vacations/downtimes

Mind Body

Soul Emotion

Spiritual engagement

Having a personal physician and mentor(s)


Self-Care

“The medical academy's primary ethical imperative may be to care for others, but this imperative is meaningless if it is divorced from the imperative to care for oneself. How can we hope to care for others, after all, if we ourselves, are crippled by ill health, burnout or resentment?”

“…medical academics must turn to an ethics that not only encourages, but even demands care of self.”

Cole, Goodrich & Gritz. “Faculty Health in Academic Medicine: Physicians, Scientists and the Pressures of Success.” Humana Press 2009; pg 7.


Self-Care

“To preserve the quality of their performance and advance the welfare of patients, dentists are encouraged to maintain their health and wellness, construed broadly as preventing or treating acute or chronic diseases, including mental illness, addictive disorders, disabilities and occupational stress.”

~ADA Policy Statement

ADA Policy Statement at: http://www.dhwcma.org/ADA%20Policy%20Statements%20on%20Dentist%20Health.pdf



Resiliency


Managing Energy

Physical Energy Spiritual Energy

Emotional Energy

Mental Energy

Schwartz, T. & McCarthy, C. Manage Your Energy Not Your Time. HBR October 2007.


Managing Energy

“Longer days at the office don’t work because time is a limited resource. But personal energy is renewable…By fostering deceptively simple rituals that help employees regularly replenish their energy, organizations build worker’s physical, emotional, and mental resilience.”

~Schwartz & McCarthy



Physical Energy











Eating and sleeping well

Physical activity

Take breaks

Identify your stressors

Manage and reduce stress





Home stressors

Work stressors



Emotional Energy







Fuel positive emotions & defuse negative emotions

∼

Express appreciation to others

∼

∼

Tell a different story “Power of Positive Thinking”

Use a different lens: reverse, long and wide

Have mentors, coaches, confidants

Self-identify which method works best for you



Spiritual Energy









Identify your “sweet spots”



What you enjoy the most?





What you do the best?

What is most important to you?

Allocate time and energy to the positives

Live your core values

Engage in spiritual renewals



Mental Energy









Reduce interruptions “switching times”

Designate “sprint zones” 90-120 m

Plan, prioritize, and accomplish

Self-identify how you plan best







Showers, car drive in/out, exercising, etc.

Check lists or to do lists

Others help provide directions



Family







Family – it is your crystal ball!!

Every other ball bounces

Family ball:











Delicate

Precious

Irreplaceable

Indispensible

Full of love


Energy: Case Discussion

Dr D is a 46 yo female physician-educator with 2 kids and spouse with significant travel/work schedule. She wears 5 different hats on any given day and is involved in several community activities. Dr D finds emails and other interruptions distracting and is feeling stressed due to a grant and several submissions that are due in the next 6 weeks. She has cut down on sleep and exercise to meet the deadlines.







Is Dr D stressed or burned out?

What are her risk factors for burnout? Will this lead to burnout?

What changes could we suggest to control energy at work?



Resiliency


Emotional Intelligence (EI)





Emotion influences behavior such that an individual is “reasonable” in one instance and “irrational” and emotional the next moment.

Five components of EI:

1.

2.

3.

4.

5.

Self-awareness – knowing one’s emotions

Self-regulation – managing one’s emotions

Motivation – motivating oneself

Empathy – recognizing emotions in others

Social skills – handling relationships

Goleman. Emotional Intelligence Bantam Books, NY, 1994 and Goleman .What’s Makes a Leader. Best of HBR, January 2004



Resiliency


Mindfulness











The purposeful effort of training your attention

Can be used to enhance self-awareness and selfregulation

Improves self-wellbeing, self-confidence, creativity and happiness

Decreases stress and pain

Various methods:









Meditation

(sitting, laying, walking, other activity)

Journaling

Art

Conversations

15671332_BG1.jpg


Mindfulness (MBSR) Practice







1 min

Relaxation Exercise:



Visualization



Mindful body scan

Mindfulness exercise:



Breathing

Clip Art found at Bing Images


Reflection





Which area needs your attention?

Think of one activity you will do to:



Promote your wellness









Manage stress

Reduce your risk of burnout

Seek assistance for impairment

Build resiliency:

∼

Self-care

∼

∼

∼

Manage energy

Build emotional intelligence

Practice mindfulness


Making it Happen







Identify & manage stress

Identify & prevent burnout

Build resiliency









Practice self-care

Manage your energy

Strengthen your EI

Practice mindfulness

 Protect your crystal ball

 Define limits - Just Say NO!



Resources


Resources















EAP program

Center for Professionalism in Medicine (BCM)

State Physician Health Programs (PHP)

Federation of State Physician Health programs

(FSPHP)

Vandy resources: CPH, FPWC, EAP, CIH, VCAP &

CPPA programs

Private counseling services

Professional Coaching - Center for Women in Med:

Debbie Smith ( www.cwmedicine.org

)


Resources









Treatment programs

Suicide prevention hotline: 1-800-273-TALK

Substance use:

(AA, NA, Evelyn Fry, etc.)

Community-based programs: YMCA/YWCA,

Massage envy, etc.


Summary

1.

2.

3.

4.

Described the professional health and wellness spectrum.

Compare and contrast symptoms, treatments, and preventive measures for stress, burnout and impairment.

Assessed your own personal risk for burnout and impairment.

Express your willingness to modify behaviors that promote self-care and wellness by adjusting current behaviors in any or all areas needed.


The following individuals reported relevant financial relationships with commercial interests:

Conflict of Interest

Goals

Objectives

Agenda

Reflective Practice

Professional Health & Wellness

Professional Health & Wellness

Professional Health & Wellness

Spectrum

Stress

Stress

Stress

Identifying Stress Reactions

Managing Stress and Flooding

Self-Regulation Exercise

Burnout

Burnout

External & Internal Systems

Burnout

Six Sources of Burnout

Risk Factors for Burnout

Symptoms of Burnout

Burnout

Impairment

Impairment

Impairment

Progression of Substance Use

Substance Abuse

“Addiction doesn’t come heralded by a brass band, it sneaks up on you, and sometimes with extraordinary speed.”

Prevention & Treatments

Resiliency

Resiliency

Four Strategies for Enhancing

Resiliency

Self-Care

Self-Care

Self-Care

Self-Care

Self-Care

Four Strategies for Enhancing

Resiliency

Managing Energy

Managing Energy

Physical Energy

Emotional Energy

Spiritual Energy

Mental Energy

Family

Energy: Case Discussion

Four Strategies for Enhancing

Resiliency

Emotional Intelligence (EI)

Four Strategies for Enhancing

Resiliency

Mindfulness

Mindfulness (MBSR) Practice

Reflection

Making it Happen

Resources

Resources

Resources

Summary

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